A Value-Based Payment Structure for an Innovator ACO Focused on HIV Population Health
Special Projects Fund
September 28, 2017
Ending the Epidemic 2020 is an ambitious blueprint to reduce new HIV infections, prevent disease progression, and relieve poverty in New York State.
Concurrently, the State’s Medicaid program is implementing a value-based payment program that will transition away from fee-for-service payment toward a payment model based on an agreed-upon set of health outcome goals. This payment model includes the VBP Innovator Program, a new incentive program for providers to keep 100% of any savings realized from improvements in health outcomes. The VBP Innovator program offers community-based organizations (CBOs) and community health centers (CHCs) that serve HIV/AIDS populations a unique opportunity to advance Ending the Epidemic 2020 goals—allowing them to reinvest savings in innovated ways that improve the quality of care for people living with HIV/AIDS. In 2017, NYHealth awarded Amida Care a grant to develop an innovative value-based payment structure and provide training and assistance to several New York City CHCs and CBOs partnering in a new HIV-focused VBP Innovator accountable care organization (IACO).
With NYHealth funding, Amida Care helped design value-based contracts and payment structure for the IACO, which is made up of two managed care organizations, seven CHCs, and one CBO-led independent practice association. The payment contracts and structure were designed to encourage participants to refocus on value over volume outcomes for care, and established the set of health outcome goals and related benchmarks for which the IACO will compensate. Once the payment structure had been established, Amida Care gave IACO members technical assistance on capacity building and skills development needed to successfully enter into the value-based payment environment. Amida Care summarized the entire process in a white paper that described barriers, successes, lessons learned, and best practices.